South Sudan: Hepatitis E Outbreak - Sep 2023

On 26th September 2023, the National Ministry of Health declared a Hepatitis E Virus outbreak in Old Fangak, Jonglei State and Greater Pibor Administrative Area, after 3 out of 13 samples tested positive for HEV. The outbreak has affected 63 people and caused 12 deaths, with a case fatality rate of 19%. (UNICEF, 3 November 2023)

In Fangak county, Jonglei State, a Hepatitis E Virus (HEV) outbreak was declared in September 2023, with 118 cumulative cases recorded, including 6 deaths. UNICEF State Health, WASH, and SBC teams, in October 2023, mobilized a response with implementing partners and local authorities to contain the outbreak. (UNICEF, 7 December 2023)

In response to a deadly Hepatitis E outbreak in South Sudan, Doctors Without Borders/Médecins Sans Frontières (MSF) has launched a mass vaccination campaign in collaboration with the Ministry of Health to safeguard women and girls of reproductive age, who are at greatest risk of death from the disease. Since April 2023, 501 cases of Hepatitis E have been treated at the MSF hospital in Old Fangak, Jonglei state, and 21 people have died—mainly women. The fatality can be as high as 40 percent for pregnant women, and there is no cure, meaning that many people with advanced stages of illness do not survive. MSF's vaccination campaign is the first to be conducted during the acute stages of an active Hepatitis E outbreak anywhere in the world. It is made more challenging by the remoteness and isolation of the area of South Sudan where it is taking place. But if the campaign succeeds, it will save lives. (MSF, 29 January 2024)

The current outbreak in Bentiu POC continues. As of 18 September 2023, a cumulative total of 63 cases with symptoms and signs consistent with HEV disease and 12 deaths (CFR 19%) were reported from Fangak. Most cases (36.5%) are from the village of Old Fangak. The median age group affected is 33 years (Interquartile range: 2 -59). Males are the most affected accounting for 58.7% of all reported cases. (WHO, 20 Feb 2024.)

As of 24 March 2024, Hepatitis E oubreak was ongoing in South Sudan. On 04 March 2024, Warrap State government in South Sudan officially declared an outbreak of hepatitis E in Twic County, prompted by a 3-year-old girl's positive test result, marking a significant public health concern in the region. This alarming declaration came after 2 individuals exhibited symptoms consistent with hepatitis E and one positive case was confirmed in Juba after laboratory tests. PH prevention measures are underway. (WHO, 24 Mar 2024.)

The ongoing Hepatitis E outbreak is active in Rubkona county (Bentiu IDPs camp), Unity State since December 2018, in Fangak county, Jonglei State since 2023 and in Western Bahr EL-Ghazal State since February 2023 (week 8). As of week 24, 2024, in Fangak county 655 cases, with 23 reported deaths since the outbreak began in week 2 of 2023; in Rubkona county ( (Bentiu IDPs camp) , since the outbreak began in 2018, 5 619 cases and 27 deaths have been reported; in Western Bahr EL-Ghazal State, a total of 501 cases were reported, with 19 deaths. In Twic county, Warrap State, In March, an outbreak of Hepatitis E was officially declared by the State Ministry of Health, from week 6 to week 22 of 2024, a total of 32 suspected cases were reported, with no fatalities. (WHO, 14 Jul 2024)

With increased transmission, new outbreaks were reported in Twic and Abyei counties in February and June 2024, affecting four counties in South Sudan. Since the beginning of the outbreak, 6 483 cases have been reported, with nearly (90%) 5 770 cases reported from Rubkona in Bentui IDP Camp. The other cases have been reported from Fangak, 655 cases (10.1%), Twic 32 cases (0.5%) and 26 cases (0.4%) from Abyei County. All 29 deaths were from Bentui IDP Camp in Rubkona County. (WHO, 8 Sep 2024)